Evidence map›Paper›PMID 27317705›Full record

Observational studyBritish journal of anaesthesia2016

Compliance with an empirical antimicrobial protocol improves the outcome of complicated intra-abdominal infections: a prospective observational study.

M Guilbart, E Zogheib, A Ntouba, L Rebibo, J M Régimbeau, Y Mahjoub, H Dupont

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in British journal of anaesthesia, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
3.3field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Article
  5. Article
  6. Article
  7. Antibiotic use among older adults on an acute care general surgery service.Canadian journal of surgery. Journal canadien de chirurgie · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

M GuilbartDepartment of Anaesthesiology and Critical Medicine.
E ZogheibDepartment of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France.
A NtoubaDepartment of Anaesthesiology and Critical Medicine.
L RebiboDepartment of Digestive and Metabolic Surgery, Amiens University Hospital, Amiens, France.
J M RégimbeauDepartment of Digestive and Metabolic Surgery, Amiens University Hospital, Amiens, France.
Y MahjoubDepartment of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France.
H DupontDepartment of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France dupont.herve@chu-amiens.fr.
Centre Hospitalier Universitaire Amiens-Picardie · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite improvements in medical and surgical care, mortality attributed to complicated intra-abdominal infections (cIAI) remains high. Appropriate initial antimicrobial therapy (ABT) is key to successful management. The main causes of non-compliance with empirical protocols have not been clearly described.

methodsAn empirical ABT protocol was designed according to guidelines, validated in the institution and widely disseminated. All patients with cIAI (2009-2011) were then prospectively studied to evaluate compliance with this protocol and its impact on outcome. Patients were classified into two groups according to whether or not they received ABT in compliance with the protocol.

results310 patients were included: 223 (71.9%) with community-acquired and 87 (28.1%) with healthcare-associated cIAI [mean age 60(17-97) yr, mean SAPS II score 24(16)]. Empirical ABT complied with the protocol in 52.3% of patients. The appropriateness of empirical ABT to target the bacteria isolated was 80%. Independent factors associated with non-compliance with the protocol were the anaesthetist's age ≥36 yr [OR 2.1; 95%CI (1.3-3.4)] and the presence of risk factors for multidrug-resistant bacteria (MDRB) [OR 5.4; 95%CI (3.0-9.5)]. Non-compliance with the protocol was associated with higher mortality (14.9 vs 5.6%, P=0.011) and morbidity: relaparotomy (P=0.047), haemodynamic failure (P=0.001), postoperative pneumonia (P=0.025), longer duration of mechanical ventilation (P<0.001), longer ICU stay (P<0.001) and longer hospital stay (P=0.002). On multivariate logistic regression analysis, non-compliance with the ABT protocol was independently associated with mortality [OR 2.4; 95% CI (1.1-5.7), P=0.04].

conclusionsNon-compliance with empirical ABT guidelines in cIAI is associated with increased morbidity and mortality. Information campaigns should target older anaesthetists and risk factors for MDRB.

Indexed as

Anti-Infective AgentsIntraabdominal InfectionsAnti-Bacterial AgentsCross InfectionHumansProspective StudiesAnti-Bacterial AgentsAnti-Infective Agentsantimicrobial agentoutcomeprotocol compliancesecondary peritonitis

Identifiers

PMID27317705
PMCPMC4913397
OpenAlexW2443317029

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.